| NPI | 1487975975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME140319) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN MD0000054809) |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2021-10-20 |